帕金森病与肌张力障碍患者经颅超声特点分析  

The neuroimaging features of Parkinson＇s disease and dystonia by transcranial sonography

作　　者：肖芳[1] 张迎春[1] 盛余敬[1] 陈晓芳[1] 罗蔚锋[2] 毛成洁[2] 熊康平[2] 刘春风[2] 

机构地区：[1]苏州大学附属第二医院超声中心,215004 [2]苏州大学附属第二医院神经内科,215004

出　　处：《中华医学杂志》2015年第15期1135-1139,共5页National Medical Journal of China

基　　金：江苏省临床医学科技专项基金（BL2014042）;苏州市临床重点病种诊疗技术专项项目（LCZX201304）;苏州市科技发展计划指导项目（SYSD2012089）

摘　　要：目的 分析帕金森病与肌张力障碍患者经颅超声（TCS）检查的影像学变化特点.方法 对2013年3月至2014年6月苏州大学附属第二医院运动障碍性疾病专科确诊的63例帕金森患者和32例肌张力障碍患者及72名健康对照进行TCS检查,黑质（SN）回声强度分为Ⅰ～Ⅴ级进行半定量分析.单侧SN强回声≥Ⅲ级时为异常表现并测量强回声面积、计算双侧强回声总面积与中脑总面积比值（S/M）;豆状核（LN）回声强度分为Ⅰ～Ⅲ级进行半定量分析,当豆状核强回声≥Ⅱ级为异常表现并测量其面积,进行定量分析.结果 （1）半定量分析：帕金森病组SN强回声≥Ⅲ比例（60.32％,38/63）明显高于肌张力障碍组（12.50％,4/32）及健康对照组（11.11％,8/72）,差异有统计学意义（χ^2=19.67,P＜1.01χ^2=36.22,P＜0.01）;肌张力障碍组LN回声≥Ⅱ级比例（65.62％,21/32）明显高于帕金森病组（20.63％,13/63）及健康对照组（8.33％,6/72）,差异均有统计学意义（χ^2=18.69,P＜0.01;2 =37.83,P＜0.01）.（2）定量分析：帕金森病组SN回声面积的中位数和四分位数间距[M（Q）][0.73（0.53） cm^2]高于肌张力障碍组[0.56（0.53） cm^2]及健康对照组[0.44（0.19） cm^2],差异有统计学意义（H=10.05,P =0.007）.帕金森病组S/M比值M（Q）[15.7％（11.5％）]高于肌张力障碍组[13.8％（14.2％）]及健康对照组[8.9％（2.9％）],组间差异有统计学意义（H=6.96,P=0.031）.肌张力障碍组LN强回声面积（M（Q） [0.50（0.33） cm^2]高于帕金森病组[0.45（0.22） cm^2]及健康对照组[0.35（0.17） cm^2],组间差异有统计学意义,H=10.87,P=0.004）.结论 TCS可发现65.63％肌张力障碍患者的LN特异性强回声以及60.32％帕金森病患者的中脑SN特异性强回声,为帕金森病与肌张力障碍的鉴别诊断提供了一定的信息.Objective To assess the neuroimaging features of Parkinson＇s Disease and dystonia by transcranial sonography （TCS）.Methods 63 Parkinson＇s Disease patients,32 dystonia patients and 81 controls underwent TCS in blind manner.The echo of the substantia nigra （SN） was classified into Ⅰ-Ⅴ as half quantitative data.The echo of SN ≥ Ⅲ was considered to be positively enhanced,the hyperechogenicity were measured and the hyper-substantia nigra/midbrain （S/M） were calculated.The echo of the lentiform nucleus （LN） was classified into Ⅰ-Ⅲ as half quantitative data.The echo of LN ≥ Ⅱ was considered to be positively increased and were measured.Result Semi-quantitative analysis：the ratio of the patients with SN ≥ Ⅲ was greater in Parkinson＇ s Disease patients （60.32%,38/63） than in dystonia patients （12.50%,4/32） and normal controls （11.11%,8/72,χ^2 =19.67,36.22,P 〈 0.01,respectively）,the ratio of the patients with LN ≥ Ⅱ was greater in dystonia patients （65.62%,21/32） than in Parkinson＇s Disease patients （20.63 %,13/63） and in controls （8.33%,6/72,x2 =18.69,37.83,P 〈 0.01,respectively）.Quantitative analysis：the median and quartile （M/Q） of the SN hyperechogenieity area in Parkinson＇s Disease patients [0.73 （0.53） cm^2] was greater than in dystonia patients [0.56 （0.53）cm^2] and in controls [0.44（0.19） cm^2,H =10.05,P =0.007],the S/M in Parkinson＇s Disease patients was greater [15.7% （11.5%）] than in dystonia patients [（13.8% （14.2%）] and in controls [8.9%（2.9%）,H =6.96,P =0.031].The M/Q of LN hyperechogenieity area in dystonia patients was greater [0.50 （0.33） cm^2] than in Parkinson＇s Disease patients [0.45 （0.22） cm^2] and in controls [0.35 （0.17）cm^2,H =10.87,P=0.004].Conclusion TCS might find the specific hyperechogenicity of SN in Parkinson＇s Disease patients （60.32%） and hyperechogenicity of LN in dystonia patients （65.63%）,which could provide useful informations to distinguish Parkinso

关 键 词：超声检查 多普勒 经颅 帕金森病 张力障碍 变形性肌 

分 类 号：R742.5[医药卫生—神经病学与精神病学] R746[医药卫生—临床医学]